Off-Brand: A Six-Year Study of Medication Brand and Generic Name Usage in a Multi-Facility Academic Healthcare System

Abstract Background: Usage of medication brand names in electronic health records may introduce conflicts of interest, perpetuate false perceptions of brand superiority, alter prescribing practices, and cause confusion leading to errors. We sought to identify the frequency of brand name medication usage in clinical documentation, as well as factors associated with increased usage. Methods: We conducted a descriptive analysis to identify generic and brand names for 518 medications in all clinical notes written at our healthcare system between 2015 and 2020. We used string-matching and regular expressions to identify medication mentions. We conducted bivariate analyses to identify associations between brand name usage and author-, note-, and medication-level factors, and a multivariate logistic regression to clarify independent associations between individual factors and brand usage. Results: A total of 104,456,653 notes from 37,285 unique authors were included in our analysis. 162,906,009 medication mentions were identified, of which 36.0% were brand name mentions with a steady year-over-year decrease. Factors associated with usage of brand name included: author role, years since release, length and syllabic complexity of the generic name, service type, and encounter context. Over-the-counter availability did not affect usage. There was sizable individual variation between note writers. Conclusions: Usage of brand names in documentation is a multifaceted phenomenon involving ease-of-writing and pronunciation, author role and training, and time since medication approval. Our findings indicate potential avenues to reduce usage frequency, including individual clinician education and system-level changes to reduce the difference in complexity between brand names and generic names.